Hepatitis is an infection of the liver caused by one of several viruses, the most common of which are named hepatitis A, B, and C. Hepatitis A is spread mainly through contaminated food and water, whereas hepatitis B is transmitted by sexual contact and use of contaminated needles. The route of transmission of hepatitis C is not completely clear but is believed to be similar to that of hepatitis B.
When you first develop hepatitis, it is called acute hepatitis. Hepatitis can also become a long-term disease known as chronic hepatitis. All forms of hepatitis cause jaundice, liver tenderness, and severe fatigue. Hepatitis A is the mildest form and seldom causes symptoms continuing longer than a couple of months. Hepatitis B and C produce more severe symptoms, which last two or three times longer, and can go on to become chronic.
Chronic hepatitis consists of persistent liver infection and inflammation that lingers long after the primary symptoms of the disease have disappeared. It can produce subtle symptoms of liver tenderness and continued fatigue and over time can gradually destroy the liver. Chronic hepatitis also appears to increase the risk of liver cancer.
The best treatment for hepatitis is prevention. You can avoid hepatitis A by practicing good hygiene and using the conventional preventive treatment, known as immune globulins, while traveling in areas where the disease is common. Hepatitis B can be prevented by immunization and the same precautions taken against HIV infection. HIV precautions almost certainly decrease the transmission of hepatitis C as well.
Conventional medicine has little in the way of treatment for the initial hepatitis infection once it has started. Treatment for chronic hepatitis is developing but is still quite imperfect. The most effective methods involve varieties of interferon.
Viral hepatitis has long been a serious problem in China and other parts of Asia, and for this reason many herbal formulas to treat it have been devised. The traditional Chinese herbal combination Shosaiko-to (Minor Bupleurum) has been approved as a treatment for chronic hepatitis by the Japanese Health Ministry.37 However, a search of the literature uncovered only one large-scale, double-blind, placebo-controlled study supporting its effectiveness.38 In this 24-week trial, the efficacy of Shosaiko-to was tested in 222 people with chronic active hepatitis using a double-blind, placebo-controlled, crossover design. Results showed that use of Shosaiko-to significantly improved liver function measurements compared to placebo. Although these results are promising, an absence of long-term evaluation limits their meaningfulness. (Researchers only followed participants for 3 months.)
Other combination Chinese herbal therapies have also shown a bit of promise for the treatment of chronic hepatitis, including those named Bing Gan Tang, Yi Zhu decoction, Fuzheng Jiedu Tang, and Jianpi Wenshen recipe.40-42 However, the quality of most of these studies was again quite poor. In a review of 10 randomized trials involving 517 people with chronic hepatitis C, researchers found that some herbs, like milk thistle, Bing Gan Tang, Yi Zhu decoction, and Yi Er Gan Tang, were associated with an improvement in lab results suggesting improved liver functioning.71 However, they ultimately concluded that there is not enough evidence to support the use of herbal medicine as a treatment for hepatitis C.
A well-designed, double-blind, placebo-controlled study evaluated a mixture of traditional Chinese herbs for people with hepatitis C and symptoms of fatigue. 55 The tested mixture contained: Radix astragali (6%), Radix acanthopanax (8%), Radix bupleuir (8%), Radix et tuber curcumae (10%), Rhizoma polygonum (10%), Radix glycyrrhiza (4%), Radix isatis (14%), Radix paeoniae rubra (14%), Radix salviae (14%), and Herba taraxaci (12%). However, it failed to prove more effective than placebo regarding symptoms or objective signs. Another complex Chinese herbal combination has also failed to prove effective.60
One Chinese herb widely advocated for chronic hepatitis B, Sophorae flavescentis, has not yet been shown effective, according to a comprehensive review of studies.56
In support of Chinese herbal therapy, researchers reviewing 26 randomized controlled trials concluded that the combination of Chinese herbs with interferon (a standard medication used to treat chronic viral hepatitis) resulted in better treatment response, fewer cases of relapse, fewer adverse events, and improved lab results compared to interferon alone.72
Note : There are many incidents in which use of Chinese herbs for treatment of hepatitis appears to have caused serious liver injury.43,64 For this reason, we do not recommend using Chinese herbs for hepatitis, except under the supervision of a physician.
For more information, see the article on Traditional Chinese Herbal Medicine.
Ayurvedic medicine, the ancient medical system of India, has many traditional treatments for hepatitis. Some of these have undergone scientific evaluation. One such is a combination treatment called Kamalahar, which contains Tecoma undulata, Phyllanthus urinaria, Embelia ribes, Taraxacum officinale, Nyctanthes arbortristis, and Terminalia arjuna. In a double-blind, placebo-controlled study, 52 people with acute hepatitis were randomly assigned to receive placebo or this combination herbal therapy at a dose of 500 mg, 3 times daily for 15 days. The results indicate that the herbal combination improved liver function to a significantly greater extent than placebo.44
Another combination therapy contains Capparis spinosa, Cichorium intybus, Solanum nigrum, Terminalia arjuna, Cassia occidentalis, Achillea millefolium, and Tamarix gallica. In a poorly reported, 5-week, double-blind, placebo-controlled study of 30 children with hepatitis A, use of this combination formula apparently improved the rate of recovery as compared to placebo.45 Benefits were also seen in a 6-week study of 34 people with acute hepatitis.46 A third double-blind, placebo-controlled study evaluated the effectiveness of this combination in the treatment of a variety of liver conditions, including chronic and acute hepatitis, and found some evidence of benefit.47
Single herbs have been tried as well. In a double-blind trial of 33 people with acute viral hepatitis, use of the herb Picrorhiza kurroa at a dose of 375 mg three times daily significantly speeded recovery time as compared to placebo.48
The herb Phyllanthus amarus has also been extensively studied as a treatment for chronic viral hepatitis, but it does not appear to be effective.27-36 Its close relative Phyllanthus urinaris has also failed to prove effective.57 Indeed, a review of 16 randomized trials including 1,326 patients concluded that there is not enough evidence to support the use of the Phyllanthus species for treating hepatitis B.74
Note that at the present, the quality of the reported studies remains poor, and Ayurvedic herbs cannot be regarded as a proven treatment for viral hepatitis. For more information, see the Ayurveda article.
The herb milk thistle has been proposed as a supportive treatment for viral hepatitis. However, study results are mixed, regarding both chronic 1-3,59,63,70 and acute 4,5 viral hepatitis. A 2007 review of all published and unpublished studies on milk thistle as a treatment for liver disease concluded that benefits were seen only in low-quality trials, and, even in those, milk thistle did not show more than a slight benefit.66 A subsequent 2008 review of 19 randomized trials failed to find any evidence of a favorable effect on viral hepatitis.67 Since then, however, a randomized trial involving 105 people with acute hepatitis found that those who received milk thistle (140 mg, 3 times daily) for 4 weeks experienced an improvement in symptoms (eg, jaundice, dark urine, discomfort) compared to the placebo group.70 Researchers did not find any changes in the lab findings, though.
Chronic hepatitis can cause cholestasis (backup of bile in the liver). In a 2-week, double-blind study of 220 individuals with cholestasis, use of the supplement SAMe at a dose of 1,600 mg daily significantly improved liver-related symptoms as compared to placebo.49 Most participants in this study had chronic viral hepatitis.
The supplement phosphatidylcholine has shown some promise for hepatitis. In one double-blind study, it enhanced the effect of interferon in people with chronic hepatitis C, but not in those with chronic hepatitis B.50 However, in an open study phosphatidylcholine failed to produce improvements in individuals with acute hepatitis.51
One small, double-blind study found the herb picrorhiza more effective than placebo for reducing signs of liver damage in people with acute viral hepatitis.65 However, this study was highly preliminary and suffered from numerous flaws.
In Japan, an injectable combination of licorice (the herb, not the candy) and certain amino acids is used for chronic hepatitis.20 However, it is not clear whether the treatment actually works.62 Even if this were established, the results would not imply that oral licorice would have a similar effect; furthermore, the high dosages used for treatment of chronic hepatitis may cause an elevation of blood pressure and other serious medical problems. Warning: Do not inject preparations of licorice designed for oral use.
Antioxidant supplements have also failed to produce benefit.61,69 A review of 20 randomized trials involving 1,225 people with liver disease (including viral hepatitis) found that antioxidants ( beta-carotene, vitamins A, C, E, and selenium) were not linked to a reduced risk of death.69
Vitamin E has also been studied on its own as a possible treatment for chronic hepatitis B. Two small randomized trials found that vitamin E at a dose of 300 mg twice daily improved lab results, indicating that the liver was functioning better.68
Other common natural medicine recommendations for hepatitis include astragalus, cordyceps, reishi, schisandra, taurine, vitamin C, and whey protein. However, there is as yet no meaningful scientific evidence that these approaches really work.
Many natural products have the capacity to harm the liver. Furthermore, due to the generally inadequate regulation of dietary supplements that exists at the time of this writing, there are real risks that herbal products, at least, may contain liver-toxic contaminants even if the actual herbs listed on the label are safe. For this reason, we recommend that people with liver disease do not use any medicinal herbs except under the supervision of a physician. Here, we list some specific information to aid in your decision-making process.
All forms of vitamin B3 may damage the liver when taken in high doses, including niacin, niacinamide (nicotinamide), and inositol hexaniacinate. (Nutritional supplementation at the standard daily requirement level should not cause a problem.)
A great many herbs and supplements have known or suspected liver-toxic properties, including but not limited to: barberry, borage, chaparral, coltsfoot, comfrey, germander, germanium (a mineral), greater celandine, kava, kombucha, mistletoe, pennyroyal, pokeroot, sassafras, and various herbs and minerals used in traditional Chinese herbal medicine.
In addition, herbs that are not liver-toxic in themselves are sometimes adulterated with other herbs of similar appearance that are accidentally harvested in a misapprehension of their identity (for example, germander found in skullcap products). Furthermore, blue-green algae species such as spirulina may at times be contaminated with liver-toxic substances called microcystins, for which no highest safe level is known.
Some articles claim that the herb echinacea is potentially liver-toxic, but this concern appears to have been based on a misunderstanding of its constituents. Echinacea contains substances in the pyrrolizidine alkaloid family. However, while many pyrrolizidine alkaloids are liver-toxic, those found in echinacea are not believed to have that property.
Whole valerian contains liver-toxic substances called valepotriates; however, valepotriates are thought to be absent from most commercial valerian products,52 and case reports suggest that even very high doses of valerian do not harm the liver.53-54
1. Berenguer J, Carrasco D. Double-blind trial of silymarin vs. placebo in the treatment of chronic hepatitis. Munch Med Wochenschr. 1977;119:240-260.
2. Buzzelli G, Moscarella S, Giusti A, et al. A pilot study on the liver protective effect of silybin-phosphatidylcholine complex (IdB 1016) in chronic active hepatitis. Int J Clin Pharmacol Ther Toxicol. 1993;31:456-460.
3. Lirussi F, Okolicsanyi L. Cytoprotection in the nineties: experience with ursodeoxycholic acid and silymarin in chronic liver disease. Acta Physiol Hung. 1992;80:363-367.
4. Magliulo E, Gagliardi B, Fiori GP. Results of a double blind study on the effect of silymarin in the treatment of acute viral hepatitis, carried out at two medical centres [translated from German]. Med Klin. 1978;73:1060-1065.
5. Bode JC, Schmidt U, Durr HK. Silymarin for the treatment of acute viral hepatitis? Report of a controlled trial [translated from German]. Med Klin. 1977;72:513-518.
6. Magliulo E, Gagliardi B, Fiori GP. Results of a double blind study on the effect of silymarin in the treatment of acute viral hepatitis, carried out at two medical centres [translated from German]. Med Klin. 1978;73:1060-1065.
7. Schulz V, Hansel R, Tyler VE. Rational Phytotherapy: A Physicians' Guide to Herbal Medicine 3rd ed. Berlin, Germany: Springer-Verlag; 1998:216.
8. Hikino H, Kiso Y. Natural products for liver disease. Econ Med Plant Res. 1988;2:39-72.
9. Muzes G, Deak G, Lang I, et al. Effects of silymarin (Legalon) therapy on the antioxidant defense mechanism and lipid peroxidation in alcoholic liver disease [in Hungarian]. Orv Hetil. 1990;131:863-866.
10. Lorenz D, Lucker PW, Mennicke WH, et al. Pharmacokinetic studies with silymarin in human serum and bile. Methods Find Exp Clin Pharmacol. 1984;6:655-661.
11. Dehmlow C, Erhard J, de Groot H. Inhibition of Kupffer cell functions as an explanation for the hepatoprotective properties of silibinin. Hepatology. 1996;23:749-754.
12. Comoglio A, Tomasi A, Malandrino S, et al. Scavenging effect of silipide, a new silybin-phospholipid complex, on ethanol-derived free radicals. Biochem Pharmacol. 1995;50:1313-1316.
20. Arase Y, Ikeda K, Murashima N, et al. The long term efficacy of glycyrrhizin in chronic hepatitis C patients. Cancer. 1997;79:1494-1500.
21. Liu JP, McIntosh H, Lin H. Chinese medicinal herbs for chronic hepatitis B (Cochrane Review). Cochrane Database Syst Rev. 2001;1-27, +7 tables.
23. Civeira MP, Castilla A, Morte S, et al. A pilot study of thymus extract in chronic non-A, non-B hepatitis. Aliment Pharmacol Ther. 1989;3:395-401.
24. Bortolotti F, Cadrobbi P, Crivellaro C, et al. Effect of an orally administered thymic derivative, thymomodulin, in chronic type B hepatitis in children. Curr Ther Res. 1988;43:67-72.
25. Galli M, Crocchiolo P, Negri C, et al. Attempt to treat acute type B hepatitis with an orally administered thymic extract (thymomodulin): preliminary results. Drugs Exp Clin Res. 1985;11:665-669.
26. Raymond RS, Fallon MB, Abrams GA. Oral thymic extract for chronic hepatitis C in patients previously treated with interferon. A randomized, double-blind, placebo-controlled trial. Ann Intern Med. 1998;129:797-800.
27. Berk L, de Man RA, Schalm SW, et al. Beneficial effects of Phyllanthus amaru s for chronic hepatitis B. J Hepatol. 1991;12:405-406.
28. Calixto JB, Santos AR, Cechinel Filho V, et al. A review of the plants of the genus Phyllanthus: their chemistry, pharmacology, and therapeutic potential. Med Res Rev. 1998;18:225-258.
29. Leelarasamee A, Trakulsomboon S, Maunwongyathi P, et al. Failure of Phyllanthus amarus to eradicate hepatitis B surface antigen from symptomless carriers. Lancet. 1990;335:1600-1601.
30. Thyagarajan SP, Jayaram S, Valliammai T, et al. Phyllanthus amarus and hepatitis B. Lancet. 1990;336:949-950.
31. Thamlikitkul V, Wasuwat S, Kanchanapee P. Efficacy of Phyllanthus amarus for eradication of hepatitis B virus in chronic carriers. J Med Assoc Thai. 1991;74:381-385.
32. Doshi JC, Vaidya AB, Antarkar DS, et al. A two-stage clinical trial of Phyllanthus amarus in hepatitis B carriers: failure to eradicate the surface antigen. Indian J Gastroenterol. 1994;13:7-8.
33. Milne A, Hopkirk N, Lucas CR, et al. Failure of New Zealand hepatitis B carriers to respond to Phyllanthus amarus.Med J. 1994;107:243.
34. Narendranathan M, Remla A, Mini PC, et al. A trial of Phyllanthus amarus in acute viral hepatitis. Trop Gastroenterol. 1999;20:164-166.
35. Wang M, Cheng H, Li Y, et al. Herbs of the genus phyllanthus in the treatment of chronic hepatitis B: observation with three preparations from different geographic sites. J Lab Clin Med. 1995;126:350-352.
36. Thyagarajan SP, Subramanian S, Thirunalasundar T, et al. Effect of Phyllanthus amarus on chronic carriers of hepatitis B virus. Lancet. 1988;2:764-766.
37. Japanese Health Ministry confirms effectiveness of Tsumura's top-selling kampo herbal prescription. Kampo Today [serial online]. 1995;1. Available at: http://www.tsumura.co.jp/english/kthp/1-2-01.htm. Accessed November 4, 2002.
38. Hirayama C, Okumura M, Tanikawa K, et al. A multicenter randomized controlled clinical trial of Shosaiko-to in chronic active hepatitis. Gastroenterol Jpn. 1989;24:715-719.
39. McCulloch M, Broffman M, Gao J, et al. Chinese herbal medicine and interferon in the treatment of chronic hepatitis B: a meta-analysis of randomized, controlled trials. Am J Public Health. 2002;92:1619-1628.
40. Liu JP, McIntosh H, Lin H. Chinese medicinal herbs for asymptomatic carriers of hepatitis B virus infection. Cochrane Database Syst Rev. 2001;CD002231.
41. Liu JP, Manheimer E, Tsutani K, et al. Medicinal herbs for hepatitis C virus infection. Cochrane Database Syst Rev. 2001;CD003183.
42. Liu JP, McIntosh H, Lin H. Chinese medicinal herbs for chronic hepatitis B. Cochrane Database Syst Rev. 2001;CD001940.
43. Verucchi G, Calza L, Attard L, et al. Acute hepatitis induced by traditional Chinese herbs used in the treatment of psoriasis. J Gastroenterol Hepatol. 2002;17:1342-1345.
44. Das DG. A double-blind clinical trial of kamalahar, an indigenous compound preparation, in acute viral hepatitis. Indian J Gastroenterol. 1993;12:126-128.
45. Saxena S, Garg AK, Jain A. Liv.52 in infective hepatitis. A study of Liv.52 therapy in infective hepatitis in children. Current Medical Practice. 1980;5:194.
46. Sama SK, Krishnamurthy L, Ramachandran K, et al. Efficacy of Liv.52 in acute viral hepatitis. A double-blind study. Indian J Med Res. 1976;5:738.
47. Mendal JN, Roy BK. Studies with Liv.52 in the treatment of infective hepatitis, chronic active hepatitis and cirrhosis of the liver. Probe. 1983;22:217.
48. Vaidya AB, Antarkar DS, Doshi JC, et al. Picrorhiza kurroa (Kutaki) Royle ex Benth as a hepatoprotective agent—experimental & clinical studies. J Postgrad Med. 1996;42:105-108.
49. Frezza M, Surrenti C, Manzillo G, et al. Oral S-adenosylmethionine in the symptomatic treatment of intrahepatic cholestasis. A double-blind, placebo-controlled study. Gastroenterology. 1990;99:211-215.
50. Niederau C, Strohmeyer G, Heintges T, et al. Polyunsaturated phosphatidyl-choline and interferon alpha for treatment of chronic hepatitis B and C: a multi-center, randomized, double-blind, placebo-controlled trial. Leich Study Group. Hepatogastroenterology. 1998;45:797-804.
51. Guan R, Ho KY, Kang JY, et al. The effect of polyunsaturated phosphatidyl choline in the treatment of acute viral hepatitis. Aliment Pharmacol Ther. 1995;9:699-703.
52. European Scientific Cooperative on Phytotherapy. Valerianae radix. Exeter, UK: ESCOP; 1996-1997:2. Monographs on the Medicinal Uses of Plant Drugs, Fascicule 4.
53. Chan TY, Tang CH, Critchley JA. Poisoning due to an over-the-counter hypnotic, Sleep-Qik (hyoscine, cyproheptadine, valerian). Postgrad Med J. 1995;71:227-228.
54. Chan TY. An assessment of the delayed effects associated with valerian overdose [letter]. Int J Clin Pharmacol Ther. 1998;36:569.
55. Jakkula M, Boucher TA, Beyendorff U, et al. A randomized trial of Chinese herbal medicines for the treatment of symptomatic hepatitis C. Arch Intern Med. 2004;164:1341-1346.
56. Liu J, Zhu M, Shi R, Yang M. Radix Sophorae flavescentis for chronic hepatitis B: a systematic review of randomized trials. Am J Chin Med. 2003;31:337-354.
57. Chan HL, Sung JJ, Fong WF, et al. Double-blinded placebo-controlled study of Phyllanthus urinaris for the treatment of chronic hepatitis B. Aliment Pharmacol Ther. 2003;18:339-345.
58. Gunduz H, Karabay O, Tamer A, et al. N-acetylcysteine therapy in acute viral hepatitis. World J Gastroenterol. 2003;9:2698-700.
59. Gordon A, Hobbs DA, Bowden DS, et al. Effects of Silybum marianum on serum hepatitis C virus RNA, alanine aminotransferase levels and well-being in patients with chronic hepatitis C. J Gastroenterol Hepatol. 2006;21:275-280.
60. Mollison L, Totten L, Flexman J, et al. Randomized double blind placebo-controlled trial of a Chinese herbal therapy (CH100) in chronic hepatitis C. J Gastroenterol Hepatol. 2006;21:1184-1188.
61. Groenbaek K, Friis H, Hansen M, et al. The effect of antioxidant supplementation on hepatitis C viral load, transaminases and oxidative status: a randomized trial among chronic hepatitis C virus-infected patients. Eur J Gastroenterol Hepatol. 2006;18:985-989.
62. Orlent H, Hansen BE, Willems M, et al. Biochemical and histological effects of 26 weeks of glycyrrhizin treatment in chronic hepatitis C: a randomized phase II trial. J Hepatol. 2006 Jun 30. [Epub ahead of print]
63. Torres M, Rodriguez-Serrano F, Rosario DJ, et al. Does Silybum marianum play a role in the treatment of chronic hepatitis C? PR Health Sci J. 2006;23:69-74
64. Yuen MF, Tam S, Fung J, et al. Traditional Chinese medicine causing hepatotoxicity in patients with chronic hepatitis B infection: a 1-year prospective study. Aliment Pharmacol Ther. 2006;24:1179-86
65. Vaidya AB, Antarkar DS, Doshi JC, et al. Picrorhiza kurroa (Kutaki) Royle ex Benth as a hepatoprotective agent--experimental & clinical studies. J Postgrad Med. 1996;42:105-108.
66. Rambaldi A, Jacobs B, Gluud C. Milk thistle for alcoholic and/or hepatitis B or C virus liver diseases. Cochrane Database Syst Rev. 2007;CD003620.
67. Saller R, Brignoli R, Melzer J, et al. An updated systematic review with meta-analysis for the clinical evidence of silymarin. Forsch Komplement Med. 2008;15:9-20.
68. Andreone P, Gramonzi A, Bernardi M. Vitamin E for chronic hepatitis B. Ann Intern Med. 1998;128(2):156-157.
69. Bjelakovic G, Gluud LL, Nikolova D, Bjelakovic M, Nagorni A, Gluud C. Meta-analysis: antioxidant supplements for liver diseases - the Cochrane Hepato-Biliary Group. Aliment Pharmacol Ther. 2010;32(3):356-367.
70. El-Kamary SS, Shardell MD, Abdel-Hamid M, et al. A randomized controlled trial to assess the safety and efficacy of silymarin on symptoms, signs and biomarkers of acute hepatitis. Phytomedicine. 2009;16(5):391-400.
71. Liu1 J, Manheimer E, Tsutani K, Gluud C. Medicinal herbs for hepatitis C virus infection. Cochrane Library. 2001:CD003183.
72. Zhao S, Liu E, Wei K, et al. Interferon plus Chinese herbs are associated with higher sustained virological response than interferon alone in chronic Hepatitis C: a meta-analysis of randomised trials. Antiviral Res. 2011;89(2):156-164.
73. El-Kamary SS, Shardell MD, Abdel-Hamid M, et al. A randomized controlled trial to assess the safety and efficacy of silymarin on symptoms, signs and biomarkers of acute hepatitis. Phytomedicine. 2009;16(5):391-400.
74. Xia Y, Luo H, Liu JP, Gluud C. Phyllanthus species for chronic hepatitis B virus infection. Cochrane Database Syst Rev. 2011 Apr 13;4:CD008960.
Last reviewed December 2015 by EBSCO CAM Review Board Last Updated: 12/15/2015